Girl 'cured' of HIV relapses

It's been announced that a young girl thought to have been cured
of HIV following early treatment is not free of the virus.

The child, now four-years-old, was a glimmer of hope for those
affected by the virus, and those dedicating their careers to a
cure. Announcing the progress she believed had been achieved in March
2013, Johns Hopkins University virologist Deborah Persaud had said:
"This is a proof of concept that HIV can be potentially curable in
infants." It was a proud moment for the team, and an exciting
moment, heralded as the first credible hope for babies born with
the virus. However, the Associated Press reports that having been off
antiretroviral drugs -- given to anyone battling the virus -- for
more than two years, the virus has re-emerged in recent weeks and
the girl is back on treatment.

It was, however, always an unusual case.

Last year, it emerged that the child's mother had not known she
was infected with the virus until she was in labour, and so had not
been receiving the drugs normally administered to help her and the
foetus combat it. Therefore, attending paediatric HIV specialist
Hannah Gay from the University of Mississippi made the decision to
administer a particularly strong dose of three different
antiretroviral drugs within 30 hours of birth.

The reason the extraordinary case came to light is because the
child only received treatment up until she was 18-months-old. At
that point, the medical team lost contact with the mother. When
they reconnected, the child was HIV-free.

According to the AP, the "disappointing" news may affect a US
federal study that was set to mimic the aggressive course of early
treatment Gay delivered. This is partially because of ethical
concerns -- the news of the Mississippi child's apparent recovery
and the proceeding trial, was the hope many had been seeking.

This was something Louis Picker of the Vaccine and Gene Therapy
Institute at Oregon Health and Science University flagged up to
Wired.co.uk in February, 2014, following the launch of a crowdfunded campaign for an HIV
vaccine it said could be delivered to the masses "in a few
short years". Overpromising, is not something a medical
professional ever wants to do when battling such a sensitive issue.
Picker told us at the time: "I get, from the papers we publish,
heartbreaking letters all the time... from people that are
desperate. They've just got HIV and they're going to kill
themselves. Really heartbreaking letters from people looking for a
cure; looking for a way out. In a sense, because of that
experience, I see this [crowdfunding campaign] as almost a way to
exploit those people."

It's why, when Wired.co.uk spoke to Barry Peters, reader and
honorary consultant physician at Kings College London's Department
of Infectious Diseases, about the Mississippi revelation in 2013,
he urged the public to be cautious, though he was initially
enthusiastic about the news. He noted that other children had been
given drugs at equally early stages following birth, and had not
been cured, so it would be impossible at the stage the news was
announced to know whether the "cure" was down to the child's
DNA.

"We wouldn't be able to reproduce this in every child, there's
something unusual in the situation coupled with the very early
stage of giving the treatment," he said. Therefore, he suggested
the hope didn't lie in the early administering of drugs, but with
the child herself. By studying the child, he suggested: "We will
learn what the nature of the response is so even if we can't
replicate the response by giving the drugs, we can find out what
the immune system was actually doing at the time and replicate that
pattern."

It's of note that drugs administered to pregnant women with HIV
-- the standard mode of care in the UK -- has meant transmission
rates to the child during pregnancy and childbirth stand at less
than one percent. Drugs would have ordinarily been given to the
Mississippi mother up until childbirth, and a caesarean section
planned. Last year Peters noted: "Currently, the greatest success
story in the whole of HIV treatment is cutting down the risk of a
child getting infected from one in five to under one percent, and
that we've achieved."

There is one element of hope from this case, and that is what
more we can learn about how the virus is stored in the body. We
know it uses cells in specific regions of the body as reservoirs,
and the fact that it appeared dormant for so long, untraceable by
the medical team attending to the four-year-old girl, means there
is something here we do not understand well enough about these
retreat and storage mechanisms. It was thought that in the case of
the Mississippi child, the reservoirs had perhaps not been
initiated by the virus, because of the early dose of
antiretrovirals. We now know this is obviously not the case, and
this could be the key to unlocking more knowledge about the
virus.

There is only one known and verified case of an individual
battling, and defeating, HIV. Timothy Ray Brown has been free of
the virus since undergoing a bone marrow stem call transplant in
2007. The case was a highly unusual one, however. The transplant
came form an elite controller, an individual who is naturally
resistant to HIV. On top of this, Brown was suffering from
leukaemia and treatment for the disease had diminished his immune
system. When news of the Mississippi child spread last year,
Brown's haematologist Gero Hütter told Wired.co.uk "I cannot
recognise too much innovation in this case".